Acanthamoeba Keratitis/epidemiology* ; Hospitals ; Humans ; Referral and Consultation ; Retrospective Studies ; Singapore/epidemiology*

INTRODUCTIONThis study aimed to describe and compare corneal graft survival and optical outcomes following deep anterior lamellar keratoplasty (DALK) and Descemet's stripping automated endothelial keratoplasty (DSAEK) with penetrating keratoplasty (PK), and to document tectonic success of patch grafts.

MATERIALS AND METHODSThis was a retrospective, non-randomised, comparative and descriptive cohort study. A total of 139 eyes that underwent primary keratoplasty between 2000 and 2016 were included, and the following data was extracted: demographics, clinical diagnosis and primary indication, pre- and intraoperative risk factors, postkeratoplasty outcomes, and complications. Optical success was defined as good graft clarity and best corrected visual acuity (BCVA) of 6/12 or better. Graft failure was defined as irreversible corneal oedema and loss of clarity. Tectonic success in patch grafts was defined as tectonic integrity with no repeat tectonic surgical procedure required in the postoperative period.

RESULTSThe mean follow-up duration was 3.24 ± 3.47 years in the PK group (n = 16), 1.89 ± 0.86 years in the DALK group (n = 37), 2.36 ± 1.24 years in the DSAEK group (n = 53), and 2.17 ± 1.09 years in the patch graft group (n = 33). The 3-year probabilties of survival for PK, DALK, DSAEK and patch graft were 60.9%, 94.1%, 89.9%, and 67.1%, respectively. The overall percentage of complications was significantly higher for PK (81.3%), compared to DALK (48.6%), DSAEK (49.1%), and patch graft (21.2%). In the PK and DALK groups, 100% achieved DSAEK (49.1%), and patch graft (21.2%). In the PK and DALK groups, 100% achieved BCVA of 6/12 or better, while in the DSAEK group, 96.43% achieved BCVA of 6/12 or better.

CONCLUSIONFrom a similar study cohort of Asian eyes, graft survival was superior and complications were reduced for DALK and DSAEK compared to PK, but optical outcomes were comparable. Graft survival for patch graft was expectedly lower, but the incidence of complications was low.

Corneal Diseases ; surgery ; Corneal Transplantation ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Male ; Outcome Assessment (Health Care) ; Registries ; Retrospective Studies ; Singapore ; Tertiary Care Centers

Purpose: Emerging evidence from animal models suggests that intermittent hypoxia due to obstructive sleep apnea (OSA) is a risk factor for breast cancer. Despite their biological plausibility, human epidemiological studies have reported conflicting results. Therefore, we conducted a meta-analysis to delineate this relationship. Methods: We searched the PubMed, Embase, Scopus, and Cochrane Library databases for eligible studies from inception until June 6, 2021. Two reviewers selected randomized trials or observational studies reporting the association between OSA and breast cancer incidence compared with those without OSA. Two reviewers extracted relevant data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and Newcastle-Ottawa Scale (NOS). We pooled the maximally covariate-adjusted hazard ratios (HRs) using a random-effects inverse varianceweighted meta-analysis and performed pre-specified subgroup analyses. Results: We included six studies out of 1,707 records, comprising a combined cohort of 5,165,200 patients. All studies used the International Classification of Diseases codes to classify OSA and breast cancer. OSA patients had a 36% increased breast cancer risk (HR, 1.36; 95% confidence interval [CI], 1.03–1.80; N = 6, I 2 = 96%) compared to those without OSA. Most studies adjusted for confounders, such as age, sex, obesity, diabetes mellitus, alcohol use, and hypertension. Subgroup analyses for studies with (1) multivariate adjustment and (2) at least five years of follow-up yielded HRs of 1.35 (95% CI, 0.98–1.87; N = 5, I 2 = 96%) and 1.57 (95% CI, 1.14–2.18; N = 4; I 2 = 90%), respectively. One Mendelian randomization study suggested a causal relationship, with a two-fold increase in the odds of breast cancer in patients with OSA. Conclusion This meta-analysis suggested that OSA is a risk factor for breast cancer. Future studies should explore the dose-response relationship between OSA and breast cancer, and whether treatment may mitigate breast cancer risk or progression.

Kawasaki disease is a common paediatric vasculitide. It is usually diagnosed by its classical constellation of mucocutaneous signs. Recurrent Kawasaki disease is a rare phenomenon that occurs in approximately 3% of all patients diagnosed with Kawasaki disease. Its presentation is usually similar to the first episode of Kawasaki disease, and early diagnosis with prompt treatment is key in preventing associated cardiovascular morbidities. Recurrent Kawasaki disease is not well reported, and atypical presentations have not been previously reported in medical literature. Here, we report the case of a young girl with recurrent Kawasaki disease who presented atypically with acute airway obstruction secondary to retropharyngeal phlegmon.
Acute Disease ; Airway Obstruction ; diagnosis ; etiology ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; Neck ; Recurrence ; Tomography, X-Ray Computed

INTRODUCTION: Current international consensus confirms that certain histopathologic factors such as tumor morphology, histologic grade and presence of lymphovascular invasion are correlated with prognosis. This retrospective cohort study evaluated the correlation between histopathologic profile and time to disease progression (UP) within the first 1-2 years follow-up of Filipino Stage I-Ill early breast cancer patients.
METHODS: This is a retrospective cohort study which included breast cancer patients enrolled in the Department of Health¬Breast Cancer Medicine Access Program (DOH-BCMAP) at the medical oncology clinics of two tertiary hospitals in Manila. Clinical and histopathologic factors were gathered from patient records, and the patients were grouped according to the modified St. Gallen definition of risk categories for patients with breast cancer. Kaplan-Meier survival analysis determined the average UP as well as progression-free survival (PFS). Multivariate logistic regression determined factors contributing to disease progression.
RESULTS AND CONCLUSION: Of the 326 patients enrolled in this study, 18% showed progression, with a median HP of 14 months. UP was comparable among the low-, intermediate- and high-risk groups. PFS during the 1st 1-2 years follow-up was estimated to be at 78% for the high-risk group, 83% for the intermediate-risk group, and 86% for the low-risk group. During this 1st 1-2 years follow-up, no studied factors of interest were shown to be significantly correlated with outcome among this predominantly intermediate to high risk for recurrence breast cancer patients. Follow-up of this patients up to 5 or more years would define sustained gains from the DOH-BCMAP.

Human ; Male ; Female ; Breast ; Breast Neoplasms ; Consensus ; Neoplasms ; Prognosis ; Medical Oncology

Early life adversities together with genetic predispositions have been associated with elevated risks of neuropsychiatric disorders during later life. In order to investigate the underlying mechanisms, many chronic, early-life stress paradigms in multiple animal models have been developed. Previously, studies reported that maternal separation (MS) in the early postnatal stages triggers depression-and/or anxiety-like behaviors in rats. However, similar studies using mice have reported inconsistent behavioral outcomes. In this study, we sought to assess behavioral outcomes from two different early-life stress paradigms; a conventional 3-hour MS and a maternal separation with early weaning (MSEW) paradigm using C57BL/6J male mice with independent cohorts. Our data demonstrated that both MS and MSEW paradigms did not produce reported behavioral anomalies. Therefore, MS paradigms in mice require further validation and modification.
Animals ; Anxiety ; Cohort Studies ; Depression ; Genetic Predisposition to Disease ; Humans ; Male ; Mice* ; Models, Animal ; Rats ; Weaning

Background: Our country has the fastest growing number of HIV cases in the Asia-Pacific region with a 203% increase from 2010 to 2018. MTCT represents 6% of infections in children and interventions such as the PMTCT program are essential to help reduce new infant infections. Objective: To determine the outcomes of HIV-exposed infants born in PGH from 2010 to 2018 enrolled in the PMTCT program. To analyze the association of maternal and neonatal clinicodemographic factors to MTCT of HIV. Methods: A retrospective cohort study using data collected from medical records of HIV exposed infants enrolled in the program. Results: Out of 117 mother-infant pairs, only 70 met the eligibility criteria. Maternal factors showed that majority have: timely antenatal visit (56/70), maternal HIV diagnosis (70/70) and ART initiation (67/70) prior to delivery, triple lifelong maternal ART (69/70), CD4 >200 prior to delivery (52/70) and cesarean delivery (67/70). Amongst the infant factors-early infant prophylaxis (60/62), >4weeks prophylaxis duration (62/70) and replacement feeding (62/70) were noted in the majority. 2/70 infants were HIV positive. Mortality rate was 1.4% and 50% for HIV infected infants. Overall LTFU rate was 33.3%. Logistic regression showed that maternal co-infection with Hepatitis B(p=0.0275) was a possible determinant of MTCT. Infant HIV prophylaxis duration of >4 weeks had higher survival proportion(p=.0001). Conclusion The HIV MTCT rate was 2.86% upon implementation of our PMTCT program, meeting the <5% goal of WHO, suggesting that the program was an effective health intervention strategy. The high LTFU rate though should be considered in the evaluation of the program effectiveness.
HIV ; Philippines

Objective: This study aims to determine the clinical profile and course on follow-up of newborns delivered to a SARS-CoV-2 positive mother from two private tertiary hospitals. Methodology: This is a retrospective, cross-sectional study. A chart review of all neonates delivered to SARS-CoV-2 positive mothers was conducted. Subsequent interview was done to determine their clinical course and neurologic status at 3-, 6-, 9-, 12-, and 15-month-old. Data collected was presented as frequencies, percentages, or proportions. Results: Out of the 67 newborns born to SARS-CoV-2 positive mothers, three neonates tested positive for SARS-CoV-2. All three were delivered to mothers with mild symptoms, were full term, with good APGAR score and appropriate for gestational age. One was eventually intubated and managed as COVID-19 confirmed critical. Among the SARS-CoV-2 negative newborns, majority had an unremarkable neonatal outcome. Thirty-six neonates were available for follow-up: 1 expired due to aspiration pneumonia at 2 months of age, 4 were readmitted for pneumonia, UTI, acute gastroenteritis, and cow’s milk allergy. Twenty-one had infection at one point prior to this study follow-up but were all mild not requiring admission. Two had abnormal head size, while 2 had developmental delay, these 4 infants with neurological findings on follow-up were all RT-PCR negative at birth. Conclusion Maternal COVID-19 infection does not necessarily result to a neonatal infection. For those neonate swith mild symptoms, SARS-CoV-2 causality could not be established. On follow-up, there were a few who developed significant problems that have long-term implications in the overall growth and development of the child.
SARS-CoV-2

Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a "double uterus," is one of the least common amongst the MDAs. Reported here is a case of a 16 year old female with a uterus didelphys with the obstructed left hemiuteri adherent in the anterior abdominal wall, and an endometriotic cyst on the same side. She underwent hysteroscopy-guided vaginoscopy, laparoscopic left hemihysterectomy, left oophorocystectomy. Cases such as these require careful preoperative planning and diagnostic imaging for more accurate diagnosis and, hence, for the most appropriate surgical procedure to be carried out. 3D ultrasonography and Magnetic Resonance Imaging have been the most widely used imaging techniques. The goals of management are to relieve the symptoms of obstruction and to restore the normal anatomy as much as possible in order to provide the best chance for future fertility.
Uterine Didelphys

Background and Objectives: Virtual learning has been utilized in residency programs to continue training amid the COVID-19 pandemic. This study aimed to determine the knowledge, skills, and attitudes of faculty members and residents of the Department of Rehabilitation Medicine of the Philippine General Hospital towards virtual learning. Method: This is a descriptive cross-sectional study. Respectively, residents and faculty members answered the Online Learning Readiness Scale (OLRS) and Faculty Readiness to Teach Online (FRTO) through Google Forms. Results: Twenty (20) residents and 19 faculty members participated in the study. The majority of the residents preferred asynchronous learning (50%), while faculty members preferred the hybrid mode (74%). Residents’ readiness for online learning was generally high, though problems with easy distractibility (60%) and time management (40%) were revealed. Female residents had higher online communication self-efficacy compared to males (p = 0.0367). Faculty members’ perceived attitude was significantly higher than ability in course design (p = 0.00102), time management (p = 0.00159), and technical competence (p < 0.0001). Males had higher perceived ability in course design (p = 0.0320). Older age groups had lower perceived abilities in course design (p = 0.0301) and technical competence (p = 0.0371). Conclusion This study revealed the levels of readiness of residents and faculty for virtual learning. Finding indicate the need to address both issues by developing programs to enhance faculty’s online teaching abilities and observing best practices to minimize problems such as distractibility. Large-scale studies with longer time frames are also recommended.
Physical and Rehabilitation Medicine ; Internship and Residency ; Education, Distance ; Education, Distance